Role of serum and synovial procalcitonin in differentiating septic from non-septic arthritis- a prospective study

IntroductionSeptic arthritis is a serious orthopaedic emergency that must be diagnosed and managed early to prevent devastating complications. The current gold standard for diagnosing septic arthritis is synovial fluid culture, but results are delayed by 48–72 h, and the sensitivity of the test is very low. Differentiating Septic from non-septic arthritis is vital to prevent unnecessary use of antibiotics and prevent complications. Serum Procalcitonin (PCT) is a useful marker in differentiating septic from non-septic arthritis but there are very few studies that have studied the role of synovial PCT for the same.AimTo determine the role of serum and synovial PCT in differentiating acute Septic from non-septic arthritis.Materials and methodsProspective clinical study in which 60 patients presenting with acute inflammatory arthritis (<2 weeks duration) were enrolled from May 2018 to May 2020. Serum and synovial fluid samples were drawn at presentation and routine blood investigations, synovial fluid culture sensitivity, and Procalcitonin levels were measured. Patients were divided into 3 groups, with group-1 having confirmed pyogenic, group-2 having presumed pyogenic, and group-3 having non –pyogenic patients, respectively. All data was tabulated and statistically analysed using appropriate tests.ResultsMean serum PCT values in groups 1, 2 and 3 were 1.06 ± 1.11, 0.85 ± 0.74, and 0.11 ± 0.24, respectively. Patients in the Pyogenic group (group1 and group 2) had significantly higher mean serum PCT as compared to group3 (p < 0.0001). Group 1 had higher serum PCT as compared to group 2, but the difference was not significant (p = 0.58). Mean synovial PCT in group 1, 2 and 3 were 2.42 ± 1.98, 1.89 ± 1.18, and 0.22 ± 0.40, respectively. Patients in the Pyogenic group (Group1 and Group2) had significantly higher mean synovial PCT as compared to Group 3 (p < 0.0001). Group 1 had higher mean synovial PCT as compared to group 2, but the difference was not significant (p = 0.54). The area under the ROC curve of the serum levels of PCT was 0.0.895, and the area under the ROC curve of the synovial fluid levels of PCT was 0.914, which was higher than the serum PCT level.ConclusionSerum and synovial Procalcitonin may be used as a diagnostic marker in differentiating septic from inflammatory arthritis and can help in reducing unnecessary use of antibiotics and early diagnosis and management of septic arthritis, thereby preventing complications.     

沙参麦冬汤加减对阴虚肺热证肺炎支原体肺炎恢复期患者免疫炎症反应的影响

目的:观察沙参麦冬汤加减对肺炎支原体肺炎恢复期患者阴虚肺热证的疗效及对免疫炎症反应的调节作用。方法:将148例患者按随机数字表法分为对照组和观察组各74例。研究期间对照组脱落、失访2例,剔除3例完成70例;观察组脱落、失访4例,完成71例。两组患者均口服阿奇霉素片,10 mg·kg~(-1)·d~(-1),连服3 d;和匹多莫德颗粒剂,0.4～0.8 g/次,2次/d;和氨溴特罗口服溶液,2.5～15 mL/次,2次/d。对照组口服养阴清肺口服液,5～10 mL/次,2～3次/d;观察组内服沙参麦冬汤加减,1剂/d。两组疗程均为7 d。进行治疗前后咳嗽症状评分和咳嗽视觉模拟评分(VAS);记录咳嗽、肺部湿啰音,咯痰消失时间和胸片复常时间;进行治疗前后阴虚肺热证评分和莱塞斯特咳嗽问卷(LCQ)评分;检测治疗前后T淋巴细胞亚群(CD3+,CD4+,CD8+和CD4+/CD8+)和白细胞介素-6(IL-6),IL~(-1)0,肿瘤坏死因子-α(TNF-α),P物质(SP),降钙素原基因相关肽(CGRP)水平;进行治疗后安全性评价。结果:观察组疾病疗效总有效为95.77%(68/71),优于对照组的82.86%(58/70)(χ2=6.186,P0.05);观察组患者咳嗽症状积分和VAS评分均明显低于对照组(P0.01);观察组患者LCQ量表各维度评分和LCQ总分均高于对照组(P0.01);观察组患者咳嗽、肺部湿啰音、咯痰消失时间及胸片复常时间均短于对照组(P0.01);观察组CD3+,CD4+,CD4+/CD8+均高于对照组(P0.01),CD8+低于对照组(P0.01);观察组血清IL-6,IL~(-1)0,TNF-α水平和痰液中SP和CGRP水均低于对照组(P0.01)。结论:在西医常规治疗的基础上,采用沙参麦冬汤加减内服治疗MPP恢复期阴虚肺热证患者,可减轻咳嗽程度,缩短病程,改善了生活质量,提高了细胞免疫功能,减轻了炎性损伤,降低了咳嗽敏感性,有较好的临床疗效,且使用安全。     

脑脊液降钙素原及乳酸测定在早期诊断颅脑术后颅内感染的意义

目的研究降钙素原(PCT)及乳酸水平在早期诊断颅脑术后颅内感染的意义。方法颅脑术后颅内感染患者(n=20)和非颅内感染患者(n=20)的脑脊液和血液样本,检测脑脊液和血清PCT,脑脊液和血液乳酸水平等指标并进行统计分析。结果感染组脑脊液和血清PCT、乳酸水平较非感染组显著升高,差异有统计学意义(P0.05)。脑脊液PCT和乳酸水平诊断敏感性及特异性均较血清PCT和乳酸水平高。结论脑脊液PCT、乳酸在颅脑手术术后颅内感染的诊断中均有意义,其中脑脊液PCT较乳酸敏感性更高,临床应用价值更大。     

Relationship of neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin levels with the presence and severity of the preeclampsia

Objective: The aim of the present study was to evaluate changes in maternal serum neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin (PCT) concentrations in preeclampsia.

Material and method: This case–control study consisted of 40 preeclamptic and 40 healthy singleton pregnancies matched for age and body mass index. Serum NGAL and PCT levels were compared between the groups. Diagnostic performance and clinical association of these markers were evaluated.

Results: NGAL and PCT concentrations were significantly higher in preeclamptic group (p?p?=?0.001, respectively) and their levels were correlated with the severity of the preeclampsia. There were significant positive correlation between these markers and mean arterial pressure (MAP) and spot urine protein excretion. There was negative correlation between NGAL and apgar scores and fetal birth weight. Pregnancies with higher NGAL (OR: 4.89; 95% CI: 1.81–13.21) and higher PCT (OR: 6.67; 95% CI: 2.44–18.21) concentrations had higher risk for preeclampsia.

Conclusion: NGAL and PCT may be potential biomarkers for preeclampsia. Their levels increase significantly in preeclampsia and they are related to the severity of the disease. These results are in agreement with the generalized endothelial damage and persistant inflammatory status in preeclampsia. NGAL may also be an indicator for adverse neonatal outcomes with decreased placental hypoperfusion.     

白虎汤加减对老年脑卒中相关性肺炎血清降钙素原及淋巴细胞亚群改变的影响

目的研究白虎汤加减对老年脑卒中相关性肺炎患者血清降钙素原及淋巴细胞亚群改变的影响。方法选择60例老年脑卒中相关性肺炎患者,分组按照随机数字表法,将60例患者随机均分为两组。两组均给予脑卒中中后预防治疗,对照组给予哌拉西林钠他唑巴坦钠;观察组在此基础上给予白虎汤加减。观察记录两组治疗效果,并检测患者治疗前后PCT、CRP、WBC水平和淋巴细胞亚群的改变。结果在总有效率结果方面,观察组96.67%明显高于对照组80.00%,差异有统计学意义(P<0.05)。治疗后,两组患者PCT、CRP、WBC计数明显降低,观察组显著低于对照组(P<0.05)。两组患者治疗后,观察组CD3^+及CD4^+水平均明显高于对照组,CD4^+/CD8^+明显优于对照组(P<0.05)。结论白虎汤加减能有效改善老年脑卒中相关性肺炎患者血清降钙素原及淋巴细胞亚群水平,疗效确切,值得临床推广应用。     

降钙素原在恶性肿瘤患者感染诊治中的应用进展

探讨降钙素原在恶性肿瘤患者感染诊治中的应用进展，总结近年来文献对降钙素原在良、恶性疾病的临床应用状况，结果显示降钙素原对感染性疾病的诊断有重要意义，在恶性肿瘤患者的感染诊治中有较好的指示作用。     

血清CRP、降钙素原及脂肪酶对妊娠合并重症急性胰腺炎的预判价值

目的探讨血清CRP、降钙素原(PCT)及脂肪酶检测对妊娠合并重症急性胰腺炎(SAP)的临床预判价值。方法回顾性分析农垦三亚医院2011年1月-2016年1月收治的126例妊娠合并急性胰腺炎(AP)患者的临床资料。根据AP的严重程度,分为妊娠合并轻中型AP组(对照组,71例)和妊娠合并SAP组(观察组,55例)。比较2组患者妊娠期AP的临床特点,观察静脉血WBC计数、Hb、血浆Alb、血淀粉酶、CRP、PCT和脂肪酶等实验室指标。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验,选取有统计学意义的指标构建受试者工作特征曲线(ROC曲线),评价其敏感度和特异度。结果观察组血脂肪酶、PCT及CRP分别为(857.73±158.61)U/L、(10.07±4.55)ng/ml、(269.93±63.61)mg/L,明显高于对照组(590.19±138.67)U/L、(5.89±2.13)ng/ml、(202.64±39.58)mg/L(χ2值分别为7.689、15.492、7.500,P值均0.01)。ROC曲线分析显示,血脂肪酶、PCT及CRP对应曲线下面积分别为0.920、0.841和0.832,对应诊断准确度最高的临界值分别为712 U/L、7.6 ng/ml和262.0 mg/L,敏感度分别为87.9%、83.5%和81.3%,特异度分别为83.2%、86.1%和78.9%。结论血脂肪酶、PCT及CRP的升高对妊娠合并SAP有较大的早期预判价值。     

儿童肺炎支原体肺炎免疫功能、降钙素原及C-反应蛋白变化及意义

目的 检测肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）患儿免疫球蛋白、CD4＋T、CD8＋T、血清降钙素原（PCT）和C-反应蛋白（CRP）的水平,探讨其改变及临床意义.方法 收集2012年11月至2013年10月诊断为MPP的患儿126例,分为大叶性肺炎组（42例）及支气管肺炎组（84例）,以同时期儿科门诊体检的健康儿童28例为正常对照组,分别测定免疫球蛋白、PCT和CRP.结果 （1）MPP患儿IgG、IgM、IgE异常率高于正常对照组（P＜0.05）,IgA异常率无明显差异（P＞0.05）;大叶性肺炎组IgG异常率高于支气管肺炎组（P＜0.05）,IgM、IgE及IgA异常率无明显差异.（2） MPP患儿CD4＋T、CD4＋ T/CD8＋T比值较正常对照组明显降低（P＜0.05）.（3）MPP患儿血清PCT及CRP水平较正常对照组明显升高（P＜0.05）.结论 MPP患儿体液免疫与细胞免疫功能紊乱在MPP发病过程中起重要作用,且病情越重,免疫功能紊乱越明显,PCT、CRP对MPP病情评估有临床指导意义.     

即时检测全血降钙素原在急诊感染患者的应用价值

目的 评估即时检测（POCT）全血降钙素原（PCT）应用于急诊临床的可行性。方法 采用POCT法对疑诊感染患者的全血标本进行PCT测定,将结果与中心实验室检测结果进行对比。结果 与中心实验室相比,POCT法显著缩短了临床周转时间（TAT）。通过kappa检验对两种方法获得的结果进行一致性分析,结果 表明,以0.5 ng/mL和2ng/mL为临界点,kappa系数分别为0.786和0.923,两种检测方法所得结果一致性较好。结论 POCT法检测PCT快速可靠,适用于急诊临床工作。     

5项炎性指标在血流感染性疾病中的表达及其与血培养的相关性

目的探讨降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)和中性粒细胞(NEUT)、单核细胞(MONO)在一些血流感染性疾病中的表达,以及其与血培养的相关性。方法将88例血培养阳性患者按病种分为布鲁菌病(以下简称布病)、菌血症、败血症和脓毒血症4组,并且检测PCT、hs-CRP、NEUT、MONO和WBC水平,并进行比较。结果 PCT和hs-CRP水平在4组均升高,布病组的升高程度低于其他3组,差异有统计学意义(P0.05)。PCT阳性率在4组均为100.0%,hs-CRP阳性率在布病组和脓毒血症组为100.0%。WBC和NEUT水平及阳性率在其他3组明显高于布病组(P0.05),MONO水平和阳性率在布病组明显高于其他3组(P0.05)。4组PCT和hs-CRP与血培养均有高度相关(P0.05),布病组WBC和NEUT与血培养无显著相关,MONO与血培养有高度相关(P0.05),WBC和NEUT在其他3组与血培养有较好的相关性(P0.05)。结论 PCT、hs-CRP及WBC检测可作为血流感染性疾病早期的拟诊指标,可为此类疾病的早期治疗与合理使用抗菌药物提供依据。